Abstract

We experienced a case with suspected drug-induced
Hemolytic Uremic Syndrome (HUS) by immunosuppressive
drug cyclosporine (CYA). HUS developed in a 51-year- old
woman treated with CYA after ABO blood type Incompatible
Living Donor Renal Transplant (ILDRTx). Her blood type was
A positive, underwent ILDRTx from her husband whose
blood type was B positive. She had developed hemolytic
anemia with erythrocyte fragmentation, severe
thrombocytopenia and acute renal failure on the first day
after ILDRTx. It was thought with CYA-induced HUS not ABO
blood type antibody mediated rejection at that point
because the ABO blood type antibody titers did not rise,
and there were no renal graft blood flow decreases in
ultrasonography and renography. On day 2 after ILDRTx, CYA
was converted to tacrolimus. After conversion without
therapy for rejection, HUS was gradually improved. On day
20, she was discharged from our hospital with a serum
creatinine (S-Cr) level of 1.65 mg/dl, and S-Cr level was 0.86
mg/dl six years and seven months after discharge. CYAinduced
HUS is extremely rare with less than 1%, but
serious complication of CYA therapy resulting in graft loss in
many cases. Therefore early detection, early treatment is
important.